Enlargement of Regional Lymph Nodes in Renal Cell Carcinoma is Often not Due to Metastases

Studer, Urs E.; Scherz, Stephanie; Scheidegger, J. R.; Kraft, Rainer; Sonntag, R; Ackermann, Daniel; Zingg, E. J.

doi:10.1016/s0022-5347(17)39422-3

Cited by 206 publications

(83 citation statements)

References 14 publications

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“…Lymph node involvement occurs in about 15% of patients in the absence of other metastasis (22,23). CT has in the past been insensitive to detect nodal metastasis in normal sized nodes.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

et al. 2012

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ARTICLE INFO _________________________________________________________ ___________________Purpose: The purpose of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) in the preoperative staging of renal cell carcinoma (RCC). Materials and Methods:We retrospectively reviewed the clinical and pathological records of 312 patients with RCC who underwent staging MDCT before surgery. Radiographic findings were compared to the findings at surgery and pathological examination. All staging used 2009 updated TNM classification. Results: The difference in tumor size between radiographic and pathological findings was 0.21cm. In T1a group, the difference was 0.33cm. Agreement between MDCT and histopathological findings was moderate for T staging (Kappa = 0.469), fair for N staging (Kappa = 0.322), and excellent for M staging (Kappa = 0.932). The sensitivity and specificity of MDCT in detecting perinephric fat invasion were 32.26% and 85.87%, in detecting tumor thrombosis were 84% and 100%, in detecting adrenal gland invasion were 60% and 95.79%, in detecting lymph node involvement were 50% and 96.36%, in detecting distant metastasis were 100% and 99.67%, respectively. In regard to stage grouping, 237 of 314 patients were correctly staged by MDCT, with an overall accuracy of 75.48%. Conclusions: MDCT with a dynamic contrast protocol is able to delineate RCC with high accuracy. However, a great portion of tumors were overstaged by MDCT because of overestimation of tumor size and poor visualization of infiltration of the perinephric fat. In addition, nodal metastatic lesion evaluation relies on node size only and remains a difficult task.

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“…Lymph node involvement occurs in about 15% of patients in the absence of other metastasis (22,23). CT has in the past been insensitive to detect nodal metastasis in normal sized nodes.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

et al. 2012

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“…Currently, there is no imaging method that can routinely and confidently differentiate between metastases and hyperplastic nodes. 24 In the experience of Studer et al, 25 histologically positive nodes were found in only 42% of patients with enlarged nodes at preoperative computed tomography. However, the falsepositive rate for preoperative imaging has been reported to be as high as 58% to 75%.…”

Section: Commentmentioning

confidence: 95%

“…However, the falsepositive rate for preoperative imaging has been reported to be as high as 58% to 75%. 22,25 It is to be hoped that further refinements of radiologic techniques may be helpful in distinguishing between benign LNs and those with metastases. To this end, carbonic anhydrase-IX, which has been shown to be detectable in most clear cell RCC, has been investigated in connection with radiologic tumor type diagnosis and radiologic localization of metastases.…”

Section: Commentmentioning

confidence: 99%

Renal Lymph Nodes for Tumor Staging: Appraisal of 871 Nephrectomies With Examination of Hilar Fat

Mehta

Mudaliar

Ghai

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Despite decades of research, the role of lymphadenectomy in the management of renal cell carcinoma (RCC) is still not clearly defined. Before the implementation of targeted therapies, lymph node metastases were considered to be a portent of markedly decreased survival, regardless of the tumor stage. However, the role of lymphadenectomy and the relative benefit of retroperitoneal lymph node dissection in the context of modern adjunctive therapies have not been conclusively addressed in the clinical literature. The current pathologic literature does not offer clear recommendations with regard to the minimum number of lymph nodes that should be examined in order to accurately stage the pN in renal cell carcinoma. Although gross examination of the hilar fat to assess the nodal status is performed routinely, it has not yet been determined whether this approach is adequate.Objective.-To evaluate the status of lymph nodes and their rate of identification in the pathologic examination of nephrectomy specimens in adult renal malignancies.Design.-We reviewed the operative and pathology reports of 871 patients with renal malignancies treated by nephrectomy. All tumors were classified according to the seventh edition of the Tumor-Nodes-Metastasis classification. Patients were divided into 3 groups: Nx, no lymph nodes recovered; N0, negative; and N1, with positive lymph nodes. Grossly visible lymph nodes were submitted separately; as per grossing protocol, hilar fatty tissue was submitted for microscopic examination. We evaluated the factors that affected the number of lymph nodes identified and the variables that allowed the prediction of nodal involvement.Results.-Lymph nodes were recovered in 333 of 871 patients (38%): hilar in 125 patients, nonhilar in 137 patients, and hilar and nonhilar in 71 patients. Patients with positive lymph nodes (n ¼ 87) were younger, had larger primary tumors, and had lymph nodes of average size, as well as a higher pT stage, nuclear grade, and rate of metastases. Metastases were seen only in grossly identified lymph nodes (65% hilar, 16% nonhilar); all microscopic nodes were negative. Even with the microscopic examination of fat, hilar lymph nodes were recovered in only 22.5% of patients. A nonhilar route of node metastasis was suspected in 40 patients.Conclusions.-Only grossly identifiable lymph nodes, both hilar and nonhilar, were positive for metastases. Although microscopic examination of the hilar fat increased the number of lymph nodes recovered, the identification rate of these nodes was low (22.5%), and such microscopic nodes were invariably negative. Hence, microscopic examination of the hilar fat may be unnecessary. (Arch Pathol Lab Med. 2013;137:1584-1590 doi: 10.5858/arpa.2012-0485-OA) L ymph node (LN) dissection represents one of the most accurate and reliable staging and therapeutic procedures for the detection of LN involvement in prostate and urinary bladder cancer patients, but its role in the management of renal cell carcinoma (RCC) is less clear.1,2 Before the ...

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“…Mevcut veriler patolojisi yüksek risk özellikte olan tümörlerde %38 oranında LN metastazının olduğunu desteklemektedir. Cerrahi öncesi radyolojik görüntüleme yöntemleri ve klinik öngörü modelleri ile LN tutulumu tahmin edilebilir (13,14,15). LN tutulum tahmininde radyografik değerlendirmelerin yeterli duyarlılığa sahip olmamasından dolayı bazı nomogromlar geliştirilmiştir.…”

Section: şEkil 1 Lenf Nodu Tutulumu Olan Ve Olmayan Hastaların Sağkaunclassified

Evaluation of Effect of Lymph Node Involvement on Prognosis of Clear Cell Renal Cell Cancer and Role of Tumor Size and Grade on Prediction of Lymph Node Involvement

Hamidi¹,

Gökçe²,

Süer³

et al. 2014

uob

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Amaç:One of the main factors affecting prognosis of renal tumors is lymph node (LN) involvement. Therefore prediction of LN involvement is quite important for prognosis of disease and survival. In this study, we aimed to identify the effect of LN involvement on survival and factors that predict LN positivity. Gereç ve Yöntem: Data of 515 patients undergoing nephrectomy with the prediagnosis of renal cell cancer between January 1996 and February 2014 was investigated retrospectively. All patients were evaluated for lymph node involvement and its effect on survival. Additionally data regarding age, gender, tumor grade and tumor size were collected and their role on prediction of LN involvement was investigated. Bulgular: The number of patients with and without pathologic LN involvement were 39 (7.6%) and 476 (92.4%), respectively. Five years overall survival rate of the patients without LN involvement was 72.3% and it was 32.3% in patients with LN involvement. In 13 (33%) of 39 LN positive patients, tumor size was greater than 10 cm. In 49 (10.2%) of 476 LN negative patients tumor size was greater than 10 cm. When 10 cm is taken as cut off value in terms of tumor size, LN positivity was found to be statistically significant (p=0.006, OR: 2.93, 95% C.I: 1.359-6.320). Fuhrman grade was determined as an independent risk factor to predict LN involvement (p=0.0001, OR: 4.96, 95% C.I: 2.117-11.635). Sonuç: Survival rate of the patients with LN metastasis was found to be worse than patients without LN involvement. Tumor size and Fuhrman grade were found as independent risk factors to predict LN metastasis.

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Enlargement of Regional Lymph Nodes in Renal Cell Carcinoma is Often not Due to Metastases

Cited by 206 publications

References 14 publications

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

Renal Lymph Nodes for Tumor Staging: Appraisal of 871 Nephrectomies With Examination of Hilar Fat

Evaluation of Effect of Lymph Node Involvement on Prognosis of Clear Cell Renal Cell Cancer and Role of Tumor Size and Grade on Prediction of Lymph Node Involvement

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